Biography

Education

  • 2021 - B.S., Biology, University of Kentucky

  • 2026 - M.D., Indiana University School of Medicine

Work History

  • 2023-2025 Research Assistant (Department of Medical and Molecular Genetics)

  • 2020-2022 Research Assistant (Spinal Cord and Brain Injury Research Center)

HISTORY

42-year-old woman

Hypertension, dyslipidemia, diabetes

Heavy menstrual bleeding, pelvic pressure, fatigue

What’s your differential?

What’s your differential?

  • Endometrial Cancer
  • Adenomyosis
  • Leiomyoma

EXAM

Enlarged uterus (~14 weeks size)

What is Your First Step in Imaging?

ACR Criteria

Ultrasound

Ultrasound

Ultrasound

Ultrasound

Diagnosis?

What kind?

Uterine fibroid types

https://www.mayoclinic.org/diseases-conditions/uterine-fibroids/symptoms-causes/

Uterine fibroid types

https://www.mayoclinic.org/diseases-conditions/uterine-fibroids/symptoms-causes/

FIGO Classification System

Submucosal Group

  • Type 0: pedunculated intracavitary

  • Type 1: <50% intramural

  • Type 2: ≥50% intramural

Uterine fibroid types

https://www.mayoclinic.org/diseases-conditions/uterine-fibroids/symptoms-causes/

FIGO Classification System

Other Group

  • Type 3: 100% intramural; contacts endometrium

  • Type 4: intramural

  • Type 5: subserosal ≥50% intramural

  • Type 6: subserosal <50% intramural

  • Type 7: subserosal pedunculated

  • Type 8: other, e.g. cervical, parasitic

Ultrasound

Ultrasound

Ultrasound

Ultrasound

What next?

ACR Criteria

MRI

MRI

Ultrasound

Cystic Degeneration

Cystic Degeneration

What next?

Patient Characteristics

Treatment Distribution by Location

Treatment Distribution by Race

Counseling Disparities

Treatment Modalities & Selection Criteria

Medical Management

  • First-line for most patients

  • Options: NSAIDs, tranexamic acid, combined oral contraceptives, progestins, LnG-IUD

  • Guideline: ACOG recommends starting with medical therapy for symptomatic management

What next?

Shared Decision-Making Essentials

Key Discussion Points:

  • Reproductive plans and timing

  • Symptom severity and impact on quality of life

  • Treatment risks and recovery expectations

  • Long-term outcomes and recurrence risks

  • Personal values and preferences

Shared Decision-Making Essentials

Key Discussion Points:

  • ACOG Practice Bulletin #228 (2021)

  • ACR Appropriateness Criteria®

  • SIR Guidelines for UAE

  • ESHRE Guidelines on Fibroid Management